Tuberc Respir Dis.  2015 Oct;78(4):459-462. 10.4046/trd.2015.78.4.459.

Progressive Pulmonary Fibrocystic Changes of Both Upper Lungs in a Patient with Ankylosing Spondylitis

• Kim DY
• Lee SJ
• Ryu YJ
• Lee JH
• Chang JH
• Kim Y

• KMID: 2320728
• DOI: http://doi.org/10.4046/trd.2015.78.4.459

Abstract

Ankylosing spondylitis is a chronic inflammatory multisystem disease that primarily affects the axial joints. Pleuropulmonary involvement is an uncommon extra-articular manifestation of ankylosing spondylitis. There is a wide spectrum of pulmonary parenchymal changes in ankylosing spondylitis, beginning in the early stages of the disease and increasing over time. The lesions are usually asymptomatic, and not visible on chest radiographs in early stages. We reported a case of advanced ankylosing spondylitis in a 56-year-old man with progressive pulmonary bullous fibrocystic changes on both upper lobes that were misdiagnosed as tuberculosis in the early stages of the disease.

Keyword

Spondylitis, Ankylosing; Cystic Disease of Lung

MeSH Terms

Humans
Joints
Lung*
Middle Aged
Radiography, Thoracic
Spondylitis, Ankylosing*
Tuberculosis

Figure

• 

  Figure 1 Bullous fibrocystic changes on serial chest X-rays taken in 2006 (A), 2009 (B), and 2014 (C). (A) Initial chest radiograph showing apical linear fibrotic opacities with cystic changes in both upper lobes. In addition, is internal fixation of the thoracolumbar spine for the treatment of spinal deformity due to ankylosing spondylitis, is observed. (B) Follow-up chest radiograph taken at the first admission due to pneumonia demonstrates consolidation in both lungs and marked progression of apical fibrobullous changes. (C) Last follow-up chest radiograph reveals increased size of bullous cysts in both upper lobes. Patchy consolidations are also noted in both lower lungs, suggestive of superinfection.

• 

  Figure 2 Bullous fibrocystic changes in serial chest high-resolution computed tomography (HRCT) taken in 2009 (A) and 2014 (B). (A) HRCT showing linear fibrotic opacities and bullae in both lungs. Combined consolidations in both lungs and small pleural effusion are suggestive of combined infection. (B) Follow-up HRCT reveals progression of fibrobullous lesions with increasing bullae size.

Reference

1. Quismorio FP Jr. Pulmonary involvement in ankylosing spondylitis. Curr Opin Pulm Med. 2006; 12:342–345.

2. El Maghraoui A. Pleuropulmonary involvement in ankylosing spondylitis. Joint Bone Spine. 2005; 72:496–502.

3. Hasiloglu ZI, Havan N, Rezvani A, Sariyildiz MA, Erdemli HE, Karacan I. Lung parenchymal changes in patients with ankylosing spondylitis. World J Radiol. 2012; 4:215–219.

4. Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu O, Ogur E. Lung findings on high resolution CT in early ankylosing spondylitis. Eur J Radiol. 2003; 47:71–76.

5. Jessamine AG. Upper lung lobe fibrosis in ankylosing spondylitis. Can Med Assoc J. 1968; 98:25–29.

6. Kim YS, Na UK, Chung YT, Park CS. A case of ankylosing spondylitis associated with fibrobullous lung lesion. Tuberc Respir Dis. 1988; 35:138–143.

7. Feltelius N, Hedenstrom H, Hillerdal G, Hallgren R. Pulmonary involvement in ankylosing spondylitis. Ann Rheum Dis. 1986; 45:736–740.

8. El Maghraoui A, Dehhaoui M. Prevalence and characteristics of lung involvement on high resolution computed tomography in patients with ankylosing spondylitis: a systematic review. Pulm Med. 2012; 2012:965956.

9. Pamuk ON, Harmandar O, Tosun B, Yoruk Y, Cakir N. A patient with ankylosing spondylitis who presented with chronic necrotising aspergillosis: report on one case and review of the literature. Clin Rheumatol. 2005; 24:415–419.

10. Davies D. Ankylosing spondylitis and lung fibrosis. Q J Med. 1972; 41:395–417.

11. Thai D, Ratani RS, Salama S, Steiner RM. Upper lobe fibrocavitary disease in a patient with back pain and stiffness. Chest. 2000; 118:1814–1816.

12. Pontier S, Bigay L, Doussau S, Recco P, Lacassagne L, Didier A. Chronic necrotizing pulmonary aspergillosis and ankylosing spondylarthritis. Rev Mal Respir. 2000; 17:683–686.

13. Miller WT. Aspergillosis: a disease with many faces. Semin Roentgenol. 1996; 31:52–66.

14. Bouvier M, Guyonnet G, Tebib J, Massonnet B, Azzar D. Apical fibrosis in ankylosing spondylitis: contribution of the mucociliary clearance. Presse Med. 1988; 17:1493–1494.

15. Kanathur N, Lee-Chiong T. Pulmonary manifestations of ankylosing spondylitis. Clin Chest Med. 2010; 31:547–554.